Trump’s 100,000-Dead Projection Gets Muddied by Reopenings

(Bloomberg) -- The Trump administration’s push to get states to reopen their economies clouds efforts to predict the toll of the new coronavirus and increases uncertainty about how much America will suffer from a little-understood disease.

President Donald Trump on Sunday said he expects as many as 100,000 Covid-19 deaths in the U.S., a significantly higher estimate that comes after more than 60,000 Americans have already died. The Federal Emergency Management Agency is meanwhile preparing for another wave of dead, looking to place mobile morgues across the nation.

Evidence suggests that after weeks of social distancing and home isolation, the U.S. has been successful in flattening the curve, experts said, with Covid-19 deaths stabilizing at about 2,000 a day.

But because of the time it takes to test patients and for severe cases to develop, outcomes in states that are aggressively reopening like Georgia, Florida and Texas may not be seen for two or three weeks, said Brian Castrucci, president and chief executive of the de Beaumont Foundation, which is based in Bethesda, Maryland, and works for public health.

Nation Consumed

New cases and deaths are expected to predominantly affect vulnerable communities, with the virus having already ravaged tightly packed meat-packing plants, prisons and nursing homes.

“We may be seeing the plateau, but I don’t think we know yet what’s coming,” said Castrucci, an epidemiologist who has led health departments in Texas, Georgia and Philadelphia.

“Don’t go back into a burning building,” he said. “That’s where we are right now.”

The Trump administration is internally projecting a steady rise in cases and deaths through the summer, according to a New York Times report on Monday that cited a Homeland Security Department presentation.

The projections say that new cases could rise to nearly 200,000 a day by the end of May and the number of deaths to nearly 3,000. The Trump administration disavowed the figures, saying that they don’t align with analysis and projections from its coronavirus task force.

Reported deaths have exceeded the number of modeled deaths since roughly mid-March, while reported daily cases have been more in line with expectations, according to the presentation, which the Times posted in full. The presentation didn’t project a total number of sick or dead Americans.

Moving Targets

On Sunday, in an interview hosted by Fox News, Trump said that the coronavirus could kill as many as 100,000 people, reflecting an increase from previous projections he has emphasized of about 60,000.

The White House initially said as many as 240,000 people could die, before last month revising estimates down last month, crediting the effectiveness of social distancing.

Josh Epstein, a professor of epidemiology at New York University, said the White House is relying on a statistical model that doesn’t account for transmission.

“A model that changes all the time is just a daily update,” he said. “It’s not really a model of the broad dynamics of a disease.”

Human Factor

Projections, both from the government and academics, can vary widely. That’s in large part because outcomes rely on the data that are plugged into them, as well as the amount of social distancing that people exercise.

“People’s behavior is essentially unpredictable,” said Sen Pei, an associate research scientist of environmental health sciences at Columbia University who is part of a team modeling the coronavirus in counties across the country. “We can’t predict what will happen tomorrow.”

The University of Washington’s Institution for Health Metrics and Evaluation, which the Trump administration has relied on, projects roughly 70,000 Covid-19 deaths by Aug. 4, though the range could be as high as 114,000.

The group’s modeling doesn’t reflect how Covid-19 cases and deaths could change as more U.S. states relax social distancing measures, according to a recent note on its methodology posted online at the end of April. IHME is working on developing a framework for that and hopes to release early results in the “near future,” it said.

Epstein said that he expected increased testing to reveal new facets of the disease.

“I think you’ll discover the epidemic has actually been bigger than we thought in terms of cases. That’s bad news in one respect, but it also means the fatality rate is lower than we expected,” he said.

Introducing Uncertainty

Many states that were a concern at the start of the pandemic in the U.S. still remain so, with New York, New Jersey, Michigan and California among those with some of the highest numbers of new cases and deaths, according to data compiled by Bloomberg.

The fact that U.S. cases appear to be plateauing indicates that “the states that got hit harder early, like Michigan, and really intensely implemented social distancing have started to see maybe a greater rate of decrease than maybe other states,” said Joe Eisenberg, chair of epidemiology at the University of Michigan.

But state reopenings -- especially if they’re not done conservatively -- could throw a wrench in this dynamic, Eisenberg said. Meanwhile, the fact that numbers on cases and deaths are delayed by several weeks to a month complicates the picture of the nation’s outbreak, he and other experts said.

New York -- the epicenter of the U.S. outbreak -- alone accounts for more than one-quarter of the nation’s coronavirus deaths at 19,415 of the nearly 68,000 total. In New York City, the virus has ravaged communities like the Bronx that are poorer and more diverse than the wealthier and whiter Manhattan.

The death toll “is the number that haunts me every day,” Governor Andrew Cuomo said Monday at a news conference.

Another haunting number: FEMA is looking to more than double the number of mobile morgues in the U.S., according to the General Services Administration website. The agency currently has 169 trucks in the field and is looking to rent an additional 200, at a cost of up to $10.8 million.

New York currently has the highest number of federally distributed mobile morgues, 85, with eight in the Washington, D.C., area and 25 in California, according to the FEMA contract request.

©2020 Bloomberg L.P.